Sevoflurane Propofol

Smith I, Ding Y, White PF. Comparison of induction, maintenance, and recovery characteristics of sevoflurane-N2O and propofol-sevoflurane-N20 with propofol-iso-flurane-N20 anesthesia. Anesth Analg 1992 74(2) 253-9. 

Hypnotics. Common hypnotics are thiopental, propofol, midazolam, etomidate, ketamine and inhaled anesthetics. The incidence of hypersensitivity reactions with thiopental is rare. Recently, thiopental was involved in less than 1% of allergic reactions in France [9]. Ever since Cremophor EL, used as a solvent for some non-barbiturate hypnotics, has been avoided, many previously reported hypersensitivity reactions have disappeared. In the last French surveys, reactions to propofol accounted for less than 2.5% of allergic reactions, and reactions to midazolam, etomidate or ketamine appear to be really rare [9]. Finally, no immune-mediated immediate hypersensitivity reaction involving isoflurane, desflurane or sevoflurane has been reported despite their wide use. 

In addition to the medicines mentioned above, a number of opiate- and non-opiate-based analgesics, including COX-2 inhibitors, anaesthetics (e.g. propofol, desflurane, sevoflurane, ropivacaine, levobupivacaine and remifentanil), neuromuscular blockers (e.g. rocuronium bromid, zemuron, cisatracuiium, doxacurium. 

A higher incidence of nausea and vomiting has been reported after sevoflurane anaesthesia than when a target-controlled propofol infusion is used. 

An anxious 5-year-old child with chronic otitis media and a history of poorly controlled asthma presents for placement of ventilating ear tubes. General anesthesia is required for this short elective ambulatory surgery procedure. What preanesthetic medication should be administered Which of the three commonly used anesthetic techniques would you choose to use in this situation (1) inhalational anesthesia with sevoflurane for induction and maintenance in combination with nitrous oxide, (2) intravenous anesthesia with propofol for induction and maintenance of anesthesia in combination with remifentanil, or (3) balanced anesthesia using propofol for induction of anesthesia followed by a combination of sevoflurane and nitrous oxide for maintenance of anesthesia ... 

Recovery is sufficiently rapid with most intravenous drugs to permit their use for short ambulatory (outpatient) surgical procedures. In the case of propofol, recovery times are similar to those seen with sevoflurane and desflurane. Although most intravenous anesthetics lack antinociceptive (analgesic) properties, their potency is adequate for short superficial surgical procedures when combined with nitrous oxide or local anesthetics, or both. Adjunctive use of potent opioids (eg, fentanyl, sufentanil or remifentanil see Chapter 31) contributes to improved cardiovascular stability, enhanced sedation, and perioperative analgesia. However, opioid compounds also enhance the ventilatory depressant effects of the intravenous agents and increase postoperative emesis. Benzodiazepines (eg, midazolam, diazepam) have a slower onset and slower recovery than the barbiturates or propofol and are rarely used for induction of anesthesia. However, preanesthetic administration of benzodiazepines (eg, midazolam) can be used to provide anxiolysis, sedation, and amnesia when used as part of an inhalational, intravenous, or balanced anesthetic technique. 

Gupta A et al Comparison of recovery profile after ambulatory anesthesia with propofol, isoflurane, sevoflurane and desflurane A systematic review. Anesth Analg 2004 98 632. [PMID 14980911]... 

In a prospective, randomized study of 120 patients undergoing day-surgery, desflurane and sevoflurane were associated with shorter times to awakening, extuba-tion, and orientation than propofol by infusion (4). Average times to awakening at the end of anesthesia were 5, 5, and 8 minutes respectively. 

Both desflurane and sevoflurane significantly increase the neuromuscular blocking effects of rocuronium compared with isoflurane or propofol (20,21). 

Song D, Josh GP, White PF. Fast-track eligibility after ambulatory anesthesia a comparison of desflurane, sevoflurane, and propofol. Anesth Analg 1998 86(2) 267-73. 

In a comparison of sevoflurane and isoflurane anesthesia in 2008 patients there was a 3-4 minute reduction in time to recovery end-points with sevoflurane (19). These differences became larger in anesthetics lasting over 3 hours and were trivial in cases less than 1 hour. Patients aged over 65 years had a 5-minute increase in recovery times after receiving isoflurane. There was no significant difference in the incidence of nausea or vomiting between isoflurane, sevoflurane, and propofol. 

The characteristics of sevoflurane anesthesia have been compared with those of target-controlled infusion of propofol in 61 day-case adults undergoing surgery (25). All received nitrous oxide 50% and fentanyl 1 pg/kg. After insertion of a laryngeal mask airway the propofol target concentration was reduced from 8 to 4 pg/ml and the... 

There has been a prospective randomized comparison of 185 patients who received propofol 6-8 mg/kg/hour and sevoflurane 1.5% for maintenance of anesthesia (28). The patients were ventilated via a laryngeal mask and no muscle relaxants were given. Both agents were suitable for this technique. Emergence was significantly faster after sevoflurane but associated with more excitatory phenomena and tachycardia. 

Both desflurane and sevoflurane significantly increase the neuromuscular blocking effects of rocuronium compared with isoflurane or propofol (41,42). The effective doses of rocuronium for 50% depression of single twitch height were 95,120,130, and 150 pg/kg for desflurane, sevoflurane, isoflurane, and propofol respectively. There were no differences in recovery profiles between the four drugs using equieffective doses. Desflurane, sevoflurane, and to a lesser extent isoflurane, also potentiated the neuromuscular blocking effect of cisatracurium by 30% compared with propofol (43,44). 

Ebert TJ, Robinson BJ, Uhrich TD, Mackenthun A, Pichotta PJ. Recovery from sevoflurane anesthesia a comparison to isoflurane and propofol anesthesia. Anesthesiology 1998 89(6) 1524-31. 

Joo HS, Perks WJ. Sevoflurane versus propofol for anesthetic induction a meta-analysis. Anesth Analg 2000 91(1) 213-19. 

Watson KR, Shah MV. Clinical comparison of single agent anaesthesia with sevoflurane versus target controlled infusion of propofol. Br J Anaesth 2000 85(4) 541-6. 

McCulloch TJ, Visco E, Lam AM. Graded hypercapnia and cerebral autoregulation during sevoflurane or propofol anesthesia. Anesthesiology 2000 93(5) 1205-9. 

Philip BK, Lombard LL, Roaf ER, Drager LR, Calalang I, Philip JH. Comparison of vital capacity induction with sevoflurane to intravenous induction with propofol for adult ambulatory anesthesia. Anesth Analg 1999 89(3) 623-7. 

Smith I, Thwaites AJ. Target-controlled propofol vs. sevoflurane a double-blind, randomised comparison in day-case anaesthesia. Anaesthesia 1999 54(8) 745-52. 

Nelskyla K, Korttila K, Yli-Hankala A. Comparison of sevoflurane-nitrous oxide and propofol-alfentanil-nitrous oxide anaesthesia for minor gynaecological surgery. Br J Anaesth 1999 83(4) 576-9. 

Keller C, Sparr HJ, Brimacombe JR. Positive pressure ventilation with the laryngeal mask airway in non-paralysed patients comparison of sevoflurane and propofol maintenance techniques. Br J Anaesth 1998 80(3) 332-6. 

In another case, epileptiform activity was reported during sevoflurane anesthesia, but not with propofol in the same individual (18). 

Plasma activity of alpha-glutathione 5-transferase activity (aGT) is a more sensitive and specific marker of hepatocellular injury than transaminase activity and it correlates better with hepatic histology. Anesthesia with halothane leads to transiently raised aGT activity, but propofol and isoflurane do not. In a randomized study of plasma aGT activity during and after low-flow anesthesia with sevoflurane or isoflurane, there were no significant differences in aGT activities between the two groups during or after anesthesia (34). 

Renal impairment often follows cardiac surgery, but in a randomized trial in elective coronary artery surgery in 354 patients, sevoflurane did not produce greater increases in serum creatinine concentrations than isoflurane or propofol (38). 

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